Prognostic factors of hepatic resection for hepatocellular carcinoma with cirrhosis: univariate and multivariate analysis.

BACKGROUND AND OBJECTIVES: The objective of this investigation was to study the clinicopathological factors influencing long-term outcome of hepatocellular carcinoma (HCC) with liver cirrhosis in patients undergoing hepatectomy. Liver cirrhosis, especially the macronodular variety, has been found in up to 90% of patients with HCC. In Asia, the incidence of liver cirrhosis in patients with HCC who had undergone hepatic resection varies from 42.5% to 73.8%. However, the optimal surgical approach for HCC patients with cirrhosis is less clearly defined. Resection of the cirrhotic liver is challenging and remains controversial in the treatment of HCC.

METHODS: This study retrospectively analyzed the surgical outcomes of HCC concomitant with liver cirrhosis in 218 patients who underwent hepatic resection between 1986 and 1998. Post-resection prognostic factors were assessed using a univariate log-rank test and a multivariate Cox proportional hazards model.

RESULTS: The overall postoperative complication rate was 15.6%, while the surgical mortality rate was 8.8%. Meanwhile, the 1-, 3-, and 5-year disease-free survival rates were 50.9%, 33.98%, and 27.03%, respectively, and. the overall cumulative survival rates at 1, 3, and 5 years were 63.14%, 41.88%, and 31.83%, respectively. Applying Cox's multivariate proportional hazard model indicated that significant adverse prognostic indicators included elevated alkaline phosphatase value, tumor size >2 cm, presence of satellite lesions, and vascular invasion.

CONCLUSIONS: This investigation found that overall survival for HCC patients concomitant with liver cirrhosis who underwent hepatic resection should be stratified on the basis of the high value of alkaline phosphatase, tumor size, satellite lesions, and vascular invasion.